| NPI | 1972349462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2024-07-03 |
| Last Update Date | 2024-08-05 |